Provider Demographics
NPI:1932221231
Name:ALBUQUERQUE INDIAN HEALTH CENTER PHARMACY
Entity Type:Organization
Organization Name:ALBUQUERQUE INDIAN HEALTH CENTER PHARMACY
Other - Org Name:ALBUQUERQUE INDIAN HOSPITAL PHARMACY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHARMACY DIRECTOR, ACTING
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:505-248-4028
Mailing Address - Street 1:801 VASSAR DR NE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2725
Mailing Address - Country:US
Mailing Address - Phone:505-248-4028
Mailing Address - Fax:505-248-7642
Practice Address - Street 1:801 VASSAR DR NE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2725
Practice Address - Country:US
Practice Address - Phone:505-248-4028
Practice Address - Fax:505-248-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMEH7890Medicaid
NMEH7890Medicaid